Provider Demographics
NPI:1588676324
Name:THOMAS C ATWOOD DPM,PC
Entity Type:Organization
Organization Name:THOMAS C ATWOOD DPM,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-353-5800
Mailing Address - Street 1:2122 9TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-3089
Mailing Address - Country:US
Mailing Address - Phone:970-353-5800
Mailing Address - Fax:970-353-5854
Practice Address - Street 1:2122 9TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3089
Practice Address - Country:US
Practice Address - Phone:970-353-5800
Practice Address - Fax:970-353-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO457213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09628223Medicaid
WYW9153Medicare PIN
CO4513410001Medicare NSC
COU30741Medicare UPIN
WY4513410002Medicare NSC
COC465458Medicare PIN